15 July 2022
By Amy Neff Roth, Observer-Dispatch
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Screenings can prevent most cervical cancers by finding abnormal cervical cell changes (pre-cancer cells), so they can be treated before they have a chance to develop into cancer.
Cases of and deaths from cervical cancer have dropped sharply in New York in recent decades.
But it is still expected to kill 200 New Yorkers this year, according to the American Cancer Society.
That’s 200 deaths that could have been prevented, said Dr. Samuel Badalian, chief of women’s health for Bassett Healthcare Network. That’s because advances in prevention and screening — including a vaccine for the virus that causes most cervical cancer —and the resulting treatment of pre-cancer or early-stage cancer, have a huge impact when women follow medical recommendations, he said.
“It can be completely eliminated,” Badalian said, “if you do prevention and vaccination.”
But not everyone follows the recommendations. In New York, 80% of people who could be affected get screened for cervical cancer, according to a data analysis recently conducted by Excellus BlueCross BlueShield. That leaves one in five who don’t follow screening guidelines, the insurer pointed out in a release.
And only 24.5% of 13-year-old New Yorkers outside of New York City had gotten both doses of the human papillomavirus, or HPV, vaccine in 2020, according to the New York Health Foundation, although that number jumps to 68.7% by age 17. The shots, recommended at age 11 or 12, protect against a group of sexually transmitted viruses that can cause cervical and other cancers; the vaccine is most effective if kids are vaccinated before they become sexually active.
Raising both the screening and the vaccination numbers should make a big difference.
“It is not only preventable, if it’s caught early, it can be cured and managed,” said obstetrican-gynecologist Dr. Angel Kerney, Excellus’ medical director. “Certainly the rates of cervical cancer would be dramatically decreased if everyone had their HPV vaccine that was eligible as well as following the cervical cancer guidelines.”
What groups are at higher risk of cervical cancer?
Cervical cancer does not affect all population groups equally.
The highest incidence rate is among American Indians/Alaskan natives, followed by Hispanic and Black people, and then white people, according to the American Cancer Society. Asian people have the fewest cases of any racial group.
Kerney said Black women are 1.5 times more likely to die of cervical cancer than white women.
And according to the American Cancer Society, Dark skin people are more likely to die of cervical cancer than any other racial or ethnic group. American Indians/Alaskan natives have the second highest death rate followed by Hispanics and then whites. Asians also have the lowest death rate.
Black women may be at more risk of dying because they are more likely to face barriers to care, Kerney said: poverty, lack of health insurance, living in neighborhoods with less access, lack of transportation, lower socioeconomic status, lack of sex education, distrust of the medical field and vaccine hesitancy.
“Those are things, if we should direct some attention there,” Kerney said, “we could really decrease cervical cancer rates for everybody.”
What progress has been made?
When Badalian started his career in medicine in 1999, doctors were following guidelines set in place in the 1950s to give patients a screening Pap smear test annually. A screening test like the Pap smear is the advantage doctors have with cancers that occur in places that they can see, as opposed to something like ovarian cancer, he said.
A lot has changed in the last two decades, he said: the discovery that a virus causes most cervical cancer, a new screening for high-risk types of HPV; and new screening guidelines that don’t call for Pap smears every year; and the vaccine, approved for girls in 2006 and for boys in 2009.
Now cervical cancer can be prevented two ways: by vaccination and by office procedures to remove pre-cancers detected through screening.
“(That’s progress that) I never even imagined I was going to see in my lifetime,” Badalian said.
And he’s already seeing the payoff. Among the younger generation, those who got the first HPV shots are now about 23 or 24 years old, and aren’t having abnormal Pap smear results as often as in the past, he said.
Cervical cancer diagnoses are still coming, but mostly in patients in their 40s, 50s and 60s, he said. “We don’t see the horrific stories now,” Badalian said, “of patients in their 20s.”
The incidence of cervical cancer in New York has dropped 40% since 1976 and the death rate has been cut in half, Excellus found.
Across the country, the cancer society still expects 4,280 people to die from cervical cancer this year.
What keeps people from getting screened?
Most cervical cancers are diagnosed in patients who have never had a Pap smear or who haven’t had one recently, according to the American Cancer Society.
Current recommendations call for those with a history of normal Pap smear results to get a Pap test every three years between the ages of 21 and 29. Between the ages of 30 and 65, the recommendation is one Pap test every three years or a test for high-risk types of HPV every five years, with or without a Pap test.
In Oneida County, 88.1% of people between the ages of 21 and 65 who could be affected have been screened. In Herkimer County, that number is 86%. It’s higher in Madison County at 89.1%; and lower in Otsego County at 77.6% and Lewis County at 76%, according to state data shared by Excellus.
But the COVID-19 pandemic interfered with routine cancer screenings. The number of people reporting recent cervical cancer screenings fell by 11% nationally between 2018 and 2020, according to an American Cancer Society study published in June.
Even before the pandemic, access to health care and interest in preventive care were issues.
“The majority of the women who are not coming for the screening either they don’t health insurance … or the women, they are busy and they can’t find the time to go for a screening,” Badalian said. “This is also a problem. And the women are not taking care of their health in general; they don’t believe in preventive care.”
Some patients mistakenly think every pelvic exam with a speculum includes a Pap smear, Kerney said. But that’s not true. Exams in the emergency room, for example, will never include a Pap smear, she said.
And some older women simply think they don’t need Pap smears once they’re done with childbearing, Kerney said. She’s seen patients for the first time in years in the emergency room — where they were diagnosed with advanced cervical carcinoma, she said.
“They did not understand,” Kerney said, “that they still needed to be under the care of someone, . . . still being screened and still having those cervical evaluations.”
Footnote..
This article originally appeared on Observer-Dispatch: Cervical cancer is treatable, but preventative care is crucial
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Yours sincerely
Frank Short
